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Diabetes Update may also include links to other Web pages of special interest.

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Home A1C Testing
When I think about how much time, effort, and blood when into writing my major article this month, I sometimes wish that I could have been paid for it. It was more than six months ago that I started to review meters and test kits that will check your A1c levels at home. In that time I accumulated several computer files and a stack of paper several inches think. The blood came from the 19 A1c tests that I have had so far this year.

Honestly, however, few magazines and Web sites are interested in articles this long and this complex. Most editors nowadays would gag at a 2,300 word article like this one. The more I got into the subject the less clear the answers became.

I have been an editor myself and could have chopped it down to a standard 600 words. Perhaps that would get more people to read it. But would the oversimplification that such butchery would require be fair to my readers?

I think not. And I hope you agree.

Book Reviews:

Dana Carpender’s Magnum Opus

500 Low-Carb Recipes
Low-carb cooking has gone beyond fad to becoming the wave of the future. Nothing attests to that more than the number of these cookbooks now available. I remember a few year’s ago when Fran McCullough’s The Low-Carb Cookbook New York: Hyperion, 1997, 384 pp., $22.95) was one of the first ones that was any good. Now, Amazon.com lists about 40.

By far the best of these came to me by accident. I subscribe to Dana Carpenter’s biweekly online newsletter “Lowcarbezine!” You can subscribe through her Hold the Toast website.

I asked Dana Carpender to send me her new cookbook, 15-Minute Low-Carb Recipes, but it hasn’t been published yet. Fortunately, her publicist send me 500 Low-Carb Recipes instead. Fair Winds Press in Gloucester, Massachusetts, published this 496-page trade paperback last November for $19.95.

I have studied several of the low-carb cookbooks and have found something good in each of them. Never before, however, has any cookbook excited me like 500 Low-Carb Recipes.

By no means do I follow a low-carb diet. It is closer to low glycemic than anything. But Dana’s book certainly makes it easier for anyone to cut back on the carbs.

I found Dana’s section on hot vegetable dishes one of the most interesting. The first recipe I used was one of three that she has for brussels sprouts. I had been looking for years for a good-tasting recipe for brussels sprouts, because this cruciferous vegetable is so good for you, and never found a recipe that produced palatable results. Until now. The great success of this recipe makes this whole cookbook a winner.

In honor of my heritage I next cooked up a pot of Dana’s Portuguese soup (without potatoes). It did my ancestors’ country proud! On the agenda are two more soups, cream of cauliflower, and peanut soup.

Compared with Fran’s book, 500 Low-Carb Recipes appears a generation less traditional and more modern. The recipes are simpler and have fewer ingredients. This is one extraordinarily practical cookbook with recipes that are quite easy to prepare.

This is Dana’a second book. Her first, How I Gave Up My Low-Fat Diet and Lost 40 Pounds…and How You Can Too!, came out in 1999. 15-Minute Low-Carb Recipes is at the printer’s. I will review it here as soon as I get a copy.

News You Can Use:

Arturo’s List
The biggest and usually most interesting mailing list about diabetes moved in September. Formerly at world.std.com, the list is now one of the many hosted by Yahoo Groups. You can subscribe by sending an email to diabetesworld-subscribe@yahoogroups.com or you can browse to http://health.groups.yahoo.com/group/diabetesworld/ and join from there. There are so many messages on this list that unless you are an active participant in the dialogue, you need to make sure that you subscribe in digest form. This way you will receive just two or three emails per day, but these messages consist of all the day’s messages.

One of the reasons why this list is so good is that its owner is Dr. Arturo Rolla, an endocrinologist who teaches at Harvard and often participates on the list. Another big reason is the two moderators, who make sure that the participants stay on topic.

Now, on Yahoo Groups the list is even better. If you subscribe in digest mode, each digest starts with a summary that consists of the number of the message, the subject, and the author. This makes it even easier to see if you want to read the entire message or not.

Research News:

TUGging at GLUT 4
You might think that since nine out of 10 people with diabetes have type 2 that we would know a lot more about it than type 1. In fact, we are just beginning to understand how insulin update works with people who don’t have diabetes.

Insulin resistance, which all type 2’s have, is much more complicated
than beta cell failure, the cause of type 1. That’s not to say we
understand the cause or causes, but beta cell or pancreas transplants can
make the recipients into members of that small enviable class of people
known as “former diabetics.”Once immunosuppressive drugs are
no longer required, they could even be said to be cured.

Now, scientist at Whitehead Institute for Biomedical Research in Cambridge,
Massachusetts, say in the October 16 issue of Nature that they have
found a protein that plays an essential role in regulating a cell’s
ability to absorb glucose, the key to insulin resistance. The researchers
discovered the protein following a five-year search for molecules that control
a glucose transporter named GLUT4, according to the lead author, Jonathan
S. Bogan, who is now an assistant professor in the Section of Endocrinology
and Metabolism, Yale University School of Medicine.

They named this crucial protein “TUG.” In one sense “the name is just cutesy,” Dr. Bogan writes me. It stands for a Tether that contains a UBX domain for GLUT4. UBX is itself an acronym as is GLUT4.

“UBX is similar to domains known to be involved in the regulated degradation of specific proteins,” Dr. Bogan continued. “These domains are called ‘UBiquitin,’ because they are present ubiquitously—in all cells and at all times in humans and other animals, plants, yeast, etc.” That explains the UB of UBX, but what of the X?

“As far as I can tell, it was just another letter to use since UBA, UBL, UBD
were all taken,” Dr. Bogan replied in his third email. “The X may also signify that this particular family was something of an unknown. The UBX family is more distantly related to
ubiquitin than are other ubiquitin-like domains.”

GLUT4 as an acronym is easier. It simply means the fourth GLUcose Transporter that scientists have discovered.

TUG is one heck of an acronym encompassing as it does other acronyms. It does
make sense, though, because the “protein we identified keeps glucose
transporters inside the cell by tugging at them and preventing them from
moving to the cell surface (in the absence of insulin).”

Scientists working in the laboratory of Dr. Harvey Lodish, a co-author of the present research, in 1985 discovered the first glucose transporter. Scientists have subsequently discovered several others, including GLUT4. While most of these glucose transporters are at the cell surface, GLUT4 is usually deep inside the cell. It only moves to the surface when insulin sends a signal and is the only transporter that responds exclusively to the presence of insulin.

Dr. Bogan had a collection of about 2.4 million different proteins. How to find the needle in the haystack that controlled GLUT4?

He used tags to find TUG. Engineering GLUT4 proteins so they contained fluorescent
tags, Dr. Bogan found that one protein, TUG, had a significant effect on
GLUT4, acting as a tether that binds GLUT4 inside the cell. When insulin
reaches the cell surface, it signals TUG to release GLUT4, which then moves
to the cell surface to allow glucose absorption. These study results suggest
that excess tethering may somehow contribute to insulin resistance.

Dr. Lodish suggests that discovering this key component of the GLUT4 pathway is a significant clue for possibly identifying a diabetes drug target. “Insulin shots just overwhelm the cell and hopefully make it respond to insulin,” he says. "But so far, there aren’t any drugs that act directly on this pathway. Now we can begin to speculate, for example, that a drug which blocks TUG might enhance a cell’s ability to absorb glucose. It’s an hypothesis, but an easy one to test."

Peanut Butter Correction
Dr. John Harvey Kellogg did receive the first patent for making peanut butter
after all. In the January 2003 issue of this newsletter I cited his biography,
which stated “Making no attempt to secure patents which would let him
control the production of either peanut butter or any of his nut butters,
he announced that they were products that ‘the world ought to have;
let everybody that wants it have it, and make the best use of it.’”

That is incorrect. Correspondent Ian Taggert wrote me this month saying
that he had found the patents in a search for a school project. Dr. Kellogg filed two patents on November 4, 1895. One was for the “Process of Preparing Nutmeal” and
the other was for a “Food Compound” that mixed peanut butter
with the starch of wheat, barley, oats, or corn.

The first of these is more relevant. The U.S. Patent Office granted patent
#580,787 on April 13, 1897. It’s not easy to find on the agency’s
site, because only images—not full text—are available for those
years.

It is, however, on the Patent
Office site. And the patent does include the line that I said did not
pass my “smell test” that “√ñI obtain√ña pasty adhesive
substance that is for convenience of distinction termed ‘nut-butter.’
”

Admittedly, this is quite a stretch for
Diabetes Update. I got interested in the history of peanut butter, however, when I reported in December 2002 that a Harvard study found that women who eat at least five ounces of peanuts and peanut butter a week reduced their risk of developing type 2 diabetes by 21 percent.

Announcements:

Do You Read Traditional Chinese?
You can continue to read my Web site in American English, but now it is also becoming available in Traditional Chinese. Several of my articles have been translated into other languages, including Italian, Russian, and Czech, but this is the first time anyone has started to translate my entire diabetes site. I authorized “humble bee” to translate it all. He tells me that he comes from Taiwan, and Traditional Chinese is his mother tongue. The URL ishttp://www.twdiabetes.com.

Insulin Delivery Survey
Please click on the link in the line above. Your answers to this survey will help an innovative manufacturer of products for people with diabetes decide whether and how to proceed with an insulin delivery product.

This survey is entirely anonymous—neither your identity, nor the identity of the survey sponsor, is accessible. As thanks for completing the survey, the manufacturer will donate $1 to the American Diabetes Association for each of the first 2,000 surveys submitted.

Attention MiniMed Users
It has come to my attention that Medtronic Diabetes is no longer supplying test strips through the mail other than BD Logic strips. However, Tim Cady, the owner of Advanced Diabetes Supply, a full-line diabetes testing company, tells me that his company can provide a wide range of strips by mail order. I am myself a current customer of that company and can vouch for them. You can contact them at 1-800-730-9887 or tim@northcoast.med.

HTML Format
I send out
Diabetes Update e-mail in HTML format, which all Web browsers and most modern e-mail programs can display. HTML has live links to all the sites named in the text so that with a simple click of a mouse you can connect to the site you have just been reading about.

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